Susanna M Zuurbier1, Mandy N Lauw2, Jonathan M Coutinho3, Charles B L M Majoie4, Bronno van der Holt5, Jan J Cornelissen6, Saskia Middeldorp7, Bart J Biemond8, Jan Stam1. 1. Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands. 2. Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. 3. Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.coutinho@amc.uva.nl. 4. Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. 5. HOVON Data Centre, Erasmus MC Cancer Institute-Clinical Trial Centre, Rotterdam, The Netherlands. 6. Department of Hematology, Erasmus MC-Daniel den Hoed, Rotterdam, The Netherlands. 7. Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. 8. Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Venous thromboembolism (VTE) is a frequent complication in patients with acute lymphoblastic leukemia (ALL). A significant proportion of patients develop cerebral venous thrombosis (CVT). METHODS: To investigate risk factors for and the clinical course of CVT in ALL patients, we describe all cases of CVT which occurred in a well-defined cohort of 240 adults, treated for newly diagnosed ALL in the HOVON (Dutch-Belgian Hemato-Oncology Cooperative Group)-37 study. We conducted a nested case-control study to explore the relevance of early symptoms and risk factors for CVT in ALL patients. RESULTS: Nine of 240 patients developed CVT (4%). CVT occurred during or shortly after L-asparaginase therapy (in 8 cases) and shortly after intrathecal methotrexate injections (in all cases) during cycle I of remission induction treatment. CVT was associated with prior headache and seizures. In 5 of 9 patients with CVT, headache before the diagnosis of CVT occurred within 3 days after lumbar puncture and initially had a postural character. CONCLUSIONS: CVT is relatively common in adult ALL patients. Our data suggest that CVT in adult ALL patients results from the additive effects of multiple risk factors, with a particular role for asparaginase and the effects of lumbar punctures for intrathecal therapy.
BACKGROUND:Venous thromboembolism (VTE) is a frequent complication in patients with acute lymphoblastic leukemia (ALL). A significant proportion of patients develop cerebral venous thrombosis (CVT). METHODS: To investigate risk factors for and the clinical course of CVT in ALL patients, we describe all cases of CVT which occurred in a well-defined cohort of 240 adults, treated for newly diagnosed ALL in the HOVON (Dutch-Belgian Hemato-Oncology Cooperative Group)-37 study. We conducted a nested case-control study to explore the relevance of early symptoms and risk factors for CVT in ALL patients. RESULTS: Nine of 240 patients developed CVT (4%). CVT occurred during or shortly after L-asparaginase therapy (in 8 cases) and shortly after intrathecal methotrexate injections (in all cases) during cycle I of remission induction treatment. CVT was associated with prior headache and seizures. In 5 of 9 patients with CVT, headache before the diagnosis of CVT occurred within 3 days after lumbar puncture and initially had a postural character. CONCLUSIONS: CVT is relatively common in adult ALL patients. Our data suggest that CVT in adult ALL patients results from the additive effects of multiple risk factors, with a particular role for asparaginase and the effects of lumbar punctures for intrathecal therapy.
Authors: Irene L M Klaassen; Mandy N Lauw; Marta Fiocco; Inge M van der Sluis; Rob Pieters; Saskia Middeldorp; Marianne D van de Wetering; Hester A de Groot-Kruseman; C Heleen van Ommen Journal: Res Pract Thromb Haemost Date: 2019-02-27
Authors: Nicolas K Khattar; Fitri Sumardi; Ajmal Zemmar; Quinghua Liang; Haiyang Li; Yazhou Xing; Hugo Andrade-Barazarte; Jack L Fleming; Iype Cherian; Juha Hernesniemi; Joseph S Neimat; Robert F James; Sunil Munakomi; Dale Ding Journal: Cureus Date: 2019-06-19